Dealing with stress and coping

Compas and colleagues (2001) define coping as a “goal-directed process in which the individual orients thoughts and behaviours toward the goals of resolving the source of stress and managing emotional reactions to stress”. Coping strategies affect the way children adjust to stressful events and coping is considered a protective factor for many behavioural and emotional problems. Coping strategies can be problem-focused or emotion-focused and can be oriented to problem solving and seeking social support (approach strategies) or to manage and regulate negative emotions using denial, distraction, resignation, wishful thinking (avoidance strategies). Young siblings can change their coping strategies and improve their adaptation to difficult situations. In providing support, it is important to be aware of individual differences in this process. Stressors in the daily routine can be assessed and siblings can be helped to manage them positively.

Family life can change dramatically when a child is sick and this creates a great amount of confusion and distress. This affects the whole family, all members have to learn new routines and roles. Together with anxiety and fear over the illness, there is a sense of loss of their identity within the family. The lives of brothers and sisters can be significantly impacted when a sibling is seriously ill – they can find that their lives are constantly interrupted by the need for their sibling to attend hospital and often face periods of separation from their sibling and parents particularly during long hospital admissions. They can also struggle with a myriad of emotions – guilt that they are healthy when their sibling is ill, anger at the disruption to their life and jealousy at the attention that their sibling is receiving. They can also be scared about the future and the outlook for their sibling. There are also positive impacts and some children will identify an increase in their resilience and independence as a result of their siblings illness and a sense that ‘they can cope with whatever life brings’.

Children cope with stress in different ways, but there are some signs that indicate that they might need extra support:

Misbehaving/Acting out in negative or attention seeking ways at home or school.

Increased anxiety; clinginess.

Withdrawal

Demanding or entitled behaviours

Increased physical symptoms (headaches, wet betting)

Disrupted sleep

Moody/irritable – temper

Significant change in school performance

Being “extra good”

What can we do?

Normalising/giving a sense of routine

Practical support is provided to maintain continuity in family life. Children can perceive that some part of their world has stayed the same. Sticking to existing rules gives a feeling of control in their lives and normal schedules of activities make them feel safe. As much as possible daily routines (e.g., eating times, picking up from school) should be kept consistent and respected by the members of the family.

Having fun

Siblings should be encouraged to attend after-school events and spend time with their friends. Relatives and other carers can help them maintain their favourite hobbies. It’s important to let them know that it is okay for them to want to have fun. Parents can be supported in setting aside one-on-one activities with siblings with the only purpose to have a good time together.

Involving in the treatment and care

Siblings benefit from feeling that they are involved in their sister and brother’s care. In particular this helps to demystify the illness and elaborate appropriate coping strategies. They can acquire new skills and knowledge by meeting with other patients’ siblings, doctors and other members of the health care team. They can be helped to start a journal to keep records of the new things they learn. Anxiety about what goes on at the hospital can also be alleviated by encouraging siblings to keep in touch with their sister or brother using cards, text messages or emails. They can also tape-record messages and phone their siblings at the hospital.

Open and reassuring communication

Children need information to develop their own coping strategies. Comfort, support and information should be constantly available. Answers to their questions are provided in a direct, simple, honest way. When using medical terms, professionals should make sure that the meaning of the words is clear to children.

Emotions are the feelings that you have. For example fear, anger, joy, love. As a sibling of someone with cancer, you might feel some of these emotions: Lonely – you might feel lonely because you are no longer able to play with your brother or sister with cancer like you used to. You might miss your family because they are at the hospital a lot. Worried – you might feel worried about your sick brother or sister or worried about how your other family members are feeling. You might worry about the future and what will happen for everyone in your family. Sad – you may feel sad about seeing your brother or sister so sick, or you might feel sad about changes that have happened now that your brother or sister has cancer. “It makes me feel really sad sometimes.” Angry – some brothers and sisters with a sibling with cancer may feel angry about what is happening and the effect it is having on their lives. “It makes me annoyed because it troubles mum and dad.” Scared – you might feel scared about the future for your brother or sister with cancer. “I get scared about my brother.” Frightened – it can be frightening to see your brother or sister so sick. The hospital can also seem frightening. Concerned – you might feel concerned about your sister or brother who is sick, your parents or your other brothers and sisters and family members. Upset – you might feel upset about having a brother or sister with cancer. “Sometimes I get a bit upset.” Jealous – sometimes, but not always, siblings may feel jealous or left out because their brother or sister gets more attention because they have cancer. “Sometimes I just think my brother gets too much attention… and I just feel kinda left out sometimes, normally I don’t.”